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P312. Cognitive-behavioural therapy (CBT) to manage inflammatory bowel disease (IBD): Preliminary findings

A. Mikocka-Walus1, J.M. Andrews2

1University of South Australia, School of Nursing and Midwifery, Adelaide, SA, Australia; 2Royal Adelaide Hospital, Department of Gastroenterology and Hepatology, Adelaide, Australia

Aim: Recent animal studies provide evidence for the relationship between stress, depression and gastrointestinal inflammation. Therefore, improving psychological status in IBD may not only improve quality of life but also delay or prevent relapse of IBD and thus be associated with improved physical outcomes and decreased inflammatory activity. This paper presents preliminary data on the acceptability and uptake of a CBT program designed to improve both psychological and disease status in IBD patients.

Materials and Methods: The study is a randomised controlled trial. Adult patients with quiescent/mild disease were randomly allocated to either CBT (experimental group) or usual medical care (controls) prior to being invited to participate. Baseline data were collected on all consenting subjects. CBT subjects were screened by a clinical psychologist. The experimental group had 10 weekly 2 hour CBT sessions and were reassessed at completion. Both groups were reassessed at 6 months.

Results: Of 401 subjects that met the eligibility criteria, 186 were allocated to controls and 215 to the experimental group. To date, 35 controls and 23 experimental group participants have taken part in the trial. No group difference in the change between baseline and six months status on any of the scales can be observed at this stage of the trial (the trial is still in progress). However, trends towards decreasing anxiety (a drop in the mean score from 7.7 to 6.8 in the experimental group vs. an increase from 6.2 to 6.4 in controls), improving mental quality of life (improvement in the mean score from 43.4 to 45.8 in the CBT group vs. a drop from 45.5 to 43.9 in controls) and reduced psychological stress in the experimental (a mean score of 657 reduced to 536) versus control group (a mean score of 372 reduced to 329) have been noted. The CBT program is well received by patients. To date, 151 (37%) patients declined participation, with practical issues such as distance to hospital, time, work or family commitments being the most common reasons for declining.

Conclusion: Preliminary data show a large unmet need for psychological support in IBD patients undergoing usual medical care at a busy metropolitan hospital. The early group comparisons indicate trends towards reduced anxiety and stress and improved mental quality of life in the experimental versus control group. Recruitment should be continued to reach a higher sample size. Practical daily life considerations are the main drivers of the current low response rate. This will be addressed by developing a parallel online CBT program for remote access to allow broader delivery of this intervention.